POS0933 IMPACT OF SACROILIAC JOINT STEROID INJECTION IN AXIAL SpA PATIENTS WITH BONE MARROW EDEMA ON DIFFERENT DISEASE OUTCOME MEASURES: A RANDOMIZED CONTROLLED TRIAL
Authors: S. Mahrous, A. Radwan, A. Khalifa, M. Ibraheem, F. Ali, A. Elsaman
Journal: Annals of the Rheumatic Diseases (2022)

Background Sacroiliac joint injection in axial spondyloarthritis (SpA) patients with steroid was controversial. A well designed randomized clinical trial testing its effect on different disease outcome measures particularly bone marrow edema was missing [1]. Objectives To test the effect of steroid injection in the sacroiliac joint of axial SpA patients on different disease outcome measures. Methods N = 43 were registered. They were randomly assigned into 2 groups; Group I (23 cases) received sacroiliac joint injection lidocaine hydrochloride mixed with triamcinolone, whereas Group II (22 cases) received subcutaneous saline injections. All participants fulfilled the ASAS criteria for axial SPA and they all had bone marrow edema at baseline. Outcomes measures were: Visual Analogue Scale (VAS), ASDAS, BASFI, and SPARCC scores. Participants were assessed at baseline (before and after sacroiliac joint injection) and after 3 months. Results There was a significant difference between both groups regarding pain, spine mobility, SPARCC and ASDAS scores in favor of group I. Spine mobility showed the earliest improvement, followed by pain whilst SPARCC and ASDAS scores showed improvement after 3 months. Higher disease activity, younger age, and shorter disease duration all were associated with better outcomes. Bilateral hip involvement was a predictor of poor response Conclusion Sacroiliac joint injection of lidocaine and triamcinolone in axial SpA patients is effective in controlling pain, improving function, disease activity scores, and bone marrow edema with acceptable complications and relatively sustained effect. References [1]Elsaman, A., A. Hamed, and A. Radwan, Ultrasound-guided epidural block in axial spondyloarthritis patients with limited spine mobility: a randomized controlled trial. The Korean journal of pain, 2021. 34 (1): p. 114. Table 1. Comparison between the two study groups Group I (N=24) Group II (N=23) P value* Age 35.4±6.2 33.5±6.7 0.354 Sex Male 17(77.3%) 16(76.2%) 1.000 Female 5(22.7%) 5(23.8%) VAS Before injection (0) 7.95±0.84 7.86±0.73 0.688 After injection (1) 3.55±1.44 6.95±1.02 &lt;0.001 12 weeks later (2) 4.82±1.37 7.19±0.81 &lt;0.001 P value 0 vs 1** &lt;0.001 0.003 - P value 0 vs 2** &lt;0.001 0.001 - P value 1 vs 2** &lt;0.001 0.397 - ASDAS Before injection 2.69±0.44 2.60±0.37 0.451 12 weeks later 1.51±0.44 2.40±0.46 &lt;0.001 P value ** &lt;0.001 0.022 BASFI Before injection 61.91±9.70 62.95±11.71 0.752 12 weeks later 57.50±8.13 61.24±0.53 0.199 P value ** &lt;0.001 0.081 - SPARCC Before injection 34.73±9.14 33.48±8.93 0.652 12 weeks later 15.68±6.60 30.95±7.85 &lt;0.001 P value ** &lt;0.001 0.024 - Finger to floor Before injection (0) 27.68±9.94 26.90±11.62 0.815 After injection (1) 17.09±7.00 25.48±11.23 0.005 12 weeks later (2) 19.64±7.83 26.76±11.79 0.024 P value 0 vs 1** &lt;0.001 0.001 - P value 0 vs 2** &lt;0.001 0.791 - P value 1 vs 2** 0.001 0.072 - Lateral bending Before injection (0) 21.64±5.91 22.29±4.51 0.688 After injection (1) 25.50±6.13 22.57±3.43 0.060 12 weeks later (2) 24.55±4.95 22.24±2.95 0.071 P value 0 vs 1** &lt;0.001 0.649 - P value 0 vs 2** 0.003 0.947 - P value 1 vs 2** 0.087 0.426 - * p values were calculated using Independent t test, except for the sex, where Fisher Exact test was used. ** p values for paired data was calculated using paired t test, to compare the baseline values (0) with either immediate post-injection (1) or 12 weeks later (2) values. Disclosure of Interests None declared